Post-Op Instructions

For Mild to Moderate Discomfort:

For Moderate to Severe Pain:

For moderate pain, begin with 400-600 mg Ibuprofen and 500mg Tylenol every 6 hours for 24 hours,
followed by 400mg with 500mg Tylenol every 6 hours as needed.

You may discontinue the medication as discomfort decreases.

If you experience any reaction from the medications which appear to be abnormal, stop the
medication and call our office. If this does not relieve your pain, please call us, as we may want to
prescribe you a stronger medication.

Today you have had one or more tooth colored fillings placed.
Here are some things you can expect after today’s appointment:

If you have received local anesthetic (you are numb) please refrain from eating until
this wears off. If you are hungry, drink whatever you’d like. A milkshake and/or soup
are good choices. Chewing while numb is not advised because your tongue and cheeks
can be easily damaged. Once the anesthesia has worn off, you may eat on the affected
area when you are comfortable. The restoration can be used like a tooth at this point,
but sometimes the tissue may be sore and needs to heal before normal eating can be
resumed.

Any discomfort you may have after your appointment can be handled by taking Advil or
Tylenol, or both. New research is indicating that pain relief comparable to narcotics but
without the side effects can be achieved with only 400mg of ibuprofen (Advil) and
1000mg acetaminophen (Tylenol).

Our new bonding materials look and function more like teeth than others we have had
in the past. However your new filling may not feel like tooth to your tongue. These
fillings will feel like a natural tooth in a short period of time.

After today’s appointment, you may brush and floss normally.

If your bite feels high or “off” after you are no longer numb, please call us and arrange
to have the bite adjusted. Not correcting a bite problem can create complications with
the tooth or the jaw joint.

Please feel free to contact the office with any other questions or concerns.

If you have received local anesthetic (you are numb) please refrain from eating
until this wears off. If you are hungry, drink whatever you’d like. A milkshake
and/or soup are good choices. Chewing while numb is not advised because your
tongue and cheeks can be easily damaged. Once the anesthesia has worn off, you
may eat on the area where we worked when you are comfortable. The restoration
can be used like a tooth at this point, but sometimes the tissue may be sore and
needs to heal before normal eating can be resumed.

Any discomfort you may have after your appointment can be handled by taking
Advil or Tylenol, or both. New research is indicating that pain relief comparable to
narcotics but without the side effects can be achieved with only 400mg-600mg of
ibuprofen (Advil) and 500mg acetaminophen (Tylenol).

Our new bonding materials look and function more like teeth than others we have
had in the past. However, the new restoration may not feel like tooth to your
tongue. Your new restoration will feel like a natural tooth in a short period of time.

After today’s appointment please return to a regular cleaning regimen with floss
and toothbrush. Bleaching may also resume assuming there are no other temporary
restorations in your mouth. Any portion of your tooth not covered by the
restoration is susceptible to new decay. Flossing daily and removing the plaque by
brushing will minimize any new decay.

If your bite feels high or “off” after you are no longer numb, please call us and
arrange to have the bite adjusted. Not correcting a bite problem can create
complications with the tooth or the jaw joint.

Please feel free to contact the office with any other questions or concerns.

Do not eat anything until the numbness in your mouth wears off. This will prevent you from biting your cheek or tongue.

Do not chew or bite on the treated tooth until you have had it restored by your dentist.

Be sure to brush and floss your teeth as you normally would.

If the opening in your tooth was restored with a temporary filling material, it is not unusual for a thin
layer to wear off in-between appointments. However, if you think the entire filling has come out,
contact your dentist.

Contact your dentist right away if you develop any of the following:

a visible swelling inside or outside of your mouth;

an allergic reaction to medication, including rash, hives or itching (nausea is not an allergic reaction);

a return of original symptoms; or your bite feels uneven.

What To Do Following Endodontic (Root Canal) Therapy:

We recommend that you take an analgesic medication for pain-relief within one hour of leaving our
office to allow the medication to be effective before the anesthesia administered begins to subside.
Generally only a single dose is required; however, some people may require pain relieving medication
over the next several days.

Ibuprofen (Advil, Motrin) 400-600mg every 6 hours (not to exceed 3200mg/day) is
recommend for patients able to take, non-steroidal anti-inflammatory medication, or
aspirin.

For people unable to take ibuprofen, non-steroidal medications, or aspirin, then
Acetaminophen (Tylenol) 500mg every 6 hours (not to exceed 4000mg/day)is
recommended. The consumption of alcohol is not recommended while taking
acetaminophen.

You may be prescribed a prescription pain reliever and / or antibiotic for your use and will
advise you on the appropriate use of these medications.

Minimize chewing on the affected tooth until your root canal therapy is complete and your dentist has
placed a protective restoration on your tooth. This is to avoid damage to the tooth.

Root canal treatment is only one step in returning your tooth to full function. A proper final restoration
of the tooth is extremely important in ensuring long-term success. We recommend that you contact
your dentist office to have your tooth restored within 2-4 weeks following completion of your root
canal therapy.

Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery.
There will usually be a metal healing cap level with or just above the gingival (gum) tissue.

BLEEDING Some bleeding or redness in the saliva is normal for 24 hours. Excessive
bleeding (your mouth fills up rapidly with blood) can be controlled by biting on a gauze pad
placed directly on the bleeding wound for 30 minutes. If bleeding continues please call us for
further instructions.

SWELLING Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice
pack or towel filled with ice on the cheek in the area of surgery. Apply the ice off and on every
20 minutes continuously, as much as possible, for the first day until you go to bed.

Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day
of surgery. Return to a normal diet, with the exception of hard crunchy food, as soon as possible
unless otherwise directed.

PAIN You should begin taking pain medication before you feel the local anesthetic wearing off.
For mild-moderate pain, 1 or 2 Tylenol (acetaminophen) or Extra Strength Tylenol may be taken
every 3-4 hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought
over the counter comes in 200 mg tablets: 2-3 tablets may be taken every 4 hours as needed
for pain. For severe pain, the prescribed medication should be taken as directed. Do not take
any of the above medication if you are allergic, or have been instructed by your doctor not to
take it.

ANTIBIOTICS Be sure to take the prescribed antibiotics if prescribed as directed to help
prevent infection.

ORAL HYGIENE Good oral hygiene is essential to good healing. Warm salt water rinses
(teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day as well,
especially after meals. Brushing your teeth is recommended, just be gentle in the area of the
surgery.

ACTIVITY Keep physical activities to a minimum immediately following surgery. Exercise
may cause throbbing, swelling or bleeding. We recommend no vigorous activity for 1 week after
surgery.

Patient instructions

Thoroughly brush and floss your teeth.

After removing the cap from the Opalescence PF syringe tip, express the contents evenly into
the deepest portion of the tray and toward the facial side of the tray. Approximately ¼ of the
syringe will be necessary per arch. ( 1 drop per tooth ).

Seat the tray completely and firmly over the teeth. At first, using a soft toothbrush, or clean
finger, gently remove excess gel that may flow beyond the tray’s edge. Adjust the amount after
first bleaching so that you know exactly how much you need and no excess is expressed into
trays.

For Opalescence 35% wear the tray for 30 minutes.

<>After the prescribed time, remove the tray. Brush and rinse the residual gel from the teeth and
then the tray. Do not swallow rinsed gel. The tray should be removed prior to eating and/or
drinking liquids. DO NOT smoke while bleaching.

Please remember...

Teeth are naturally darker along the gum line. These may require more time to lighten than the
rest of the tooth surface and usually remain slightly darker.

A small percentage of patients experience sensitivity with bleaching. Should this occur, contact
our office. It may be recommended that you bleach every second or third day, and use a fluoride
treatment in your custom tray on the days you do not bleach.

Food and juices high in citric acid can cause sensitivity to the teeth.

Food, drink, or tobacco can restain your teeth over time. Should this occur the teeth can be re–whitened within a few nights by using Opalescence PF.

(To be followed for the first 48 hours)

CONGRATULATIONS! You have just experienced a revolutionary tooth whitening procedure.
The next 48 hours are important in enhancing and maximizing your whitening results
for a long lasting, bright and healthy smile.

Everyone’s teeth have a protective layer called the acquired pellicle. This layer
contains the surface dental stains and is removed during a regular dental cleaning
or the whitening process. It takes twelve to twenty four hours for the barrier to
fully develop again. To maximize the whitening, we ask that for the next 48 hours,
you DO NOT consume dark or yellow staining substances such as:

All Tobacco Products

Avoid Colored Lipstick

Coffee / Tea

Red Wine

lettuce & tomatoes

Soft Drinks

Potato Chips

Mustard / Ketchup

Berries

Red Sauces

Soy Sauce

Remember that you must not use any colored toothpastes or gels for the first 48 hours.
In addition, do not use any colored mouthwash or home fluoride treatments.
If your daily homecare involves the use of Perio Rx or any Chlorahexidine,
please wait 48 hours before continuing the usage of this product. If post operative
sensitivity occurs, chew sugarless gum to reduce the peroxide levels, take an Advil
or Tylenol, or what you would normally use for a headache, and brush with Sensodyne.

Additional ways you can help maintain your white smile is to avoid staining related habits,
use an electric toothbrush, floss and have regular professional hygiene visits twice
a year to keep your smile its whitest!

We can make whitening trays in office and you can use at home with whitening gel two
times per week for 30 minutes and keep your teeth white forever.

The diode laser uses radiant energy to heal periodontal disease. The laser works two
ways: 1) it removes diseased tissue and 2) it decontaminates the periodontal pocket by
killing the disease causing bacteria living there. Laser therapy is used in conjunction
with deep cleaning.

Expect the treated area to be sore and tender to the touch for 4-7 days. Take analgesics like
Advil, Motrin or Tylenol every 4-6 hours for pain. If the treated area involves the tissue around
the last tooth on the upper or lower then you may experience a “sore throat” type if discomfort 1
or 2 days after treatment.

NO SMOKING FOR SIX (6)HOURS AFTER TREATMENT.

The treated area will bleed and be tender when you clean it. This is normal and should subside
in 7 days. If the area is extremely sore during cleaning, you may apply Oral Gel prior to your
cleaning routine.

The successful outcome of gum disease treatment is dependent upon thorough daily removal
of the bacteria that cause the disease.

It is normal to experience hot, cold, or sweet sensitivity immediately after treatment. Typically
after gum surgery the tissue shrinks and the root surface is exposed. This can be treated with
fluoride or desensitizing toothpaste. If sensitivity persists, please call for an appointment for
evaluation. You may also be prescribed fluoride to prevent decay on the root surfaces.

You may notice for the first 3-4 days that the treated area will be sensitive to hot, spicy, acidic
foods. This doesn’t mean you can’t have them, just be careful.

If you have been prescribed antimicrobial mouth rinse and or antibiotics be sure to continue
the therapy as directed. As usual, if you have any questions about any of your treatment, call
our office.

For first 20 min after extraction, keep firm pressure on extraction site and remove gauze
20 min after extraction and no longer. Drink plenty of fluids. Eat only soft foods. Avoid
foods with small kernels like nuts or popcorn. Be careful not to eat while you are numb
to prevent biting your lips, cheeks, or tongue.

No rinsing, drinking through a straw, or any kind of suction in mouth for 24
hours. Do not smoke for at least 48 hours, for this is extremely detrimental to
healing. These are all known causes of a “Dry Socket,” which is very painful.

Often there is some swelling with oral surgery. This can be minimized by using an
icepack approximately 15 min on and 15 min off during the first 12 to 24 hours. This will
help keep the swelling down and keep you comfortable. Do not use any hot compresses
unless otherwise directed by the doctor.

Take pain medication with food to prevent stomach upset. If you take the pain
medication before the anesthetic wears off, you be able to manage the discomfort
better. Remember the most severe discomfort is usually within the first six hours after
the anesthetic wears off. For moderate to severe pain, you can take only 400mg-600mg
of ibuprofen (Advil) and 500mg acetaminophen (Tylenol) every 6 hours as needed.

New research is indicating that pain relief comparable to narcotics but without the side
effects can be achieved with only 400mg-600mg of ibuprofen (Advil) and 500mg
acetaminophen (Tylenol).

Finish all antibiotics! Sleep with head slightly elevated the first night after surgery.
Starting tomorrow, rinse with warm salt-water (1tsp salt to 8 oz of water), 4 to 5
times a day. Do this for the next week. This is a very important part of the healing
process. Begin your normal oral hygiene routine as soon as possible within the bounds
of comfort. By a week after surgery, you should be back to brushing as normal.

Please return to our office in 1 week for suture removal, if instructed to do so. Please
call our office if you have any questions.

FOR POST-OP DISCOMFORT

Schedule next cleaning in 8 weeks. Then 3 month perio maintenance until
otherwise notified depending on gum health and response to therapy.

DISCOMFORT AND PAIN Discomfort immediately after the appointment is normal
and can be relieved with Tylenol, Aspirin, or Ibuprofen.

TOOTH SENSITIVITY Teeth may be sensitive to temperature changes and /or
sweets. The sensitivity to temperature may be intense at first, but usually
diminishes quickly.

BLEEDING Some slight bleeding may occur during the next several brushings, but
the bleeding should steadily decrease after two or three days.

APPEARANCE Root surfaces may be more exposed as the swelling of the
inflamed gum tissue goes away. This may result in more open spaces between
teeth.

What is Deep Cleaning (Deep Scaling & Root Planning)?

If plaque and tartar is left on the teeth, it provides the right conditions for bacteria
to thrive. The bacteria irritate the gums, which means that they bleed more easily.
You may notice this if you are brushing your teeth, or eating, and sometimes your gums
may bleed a bit. This is the early stage of gum disease called gingivitis. If you have gingivitis,
a dentist would treated them on day of visit after exam. We would also show you how
to brush and floss your teeth effectively and may prescribed antibiotic. Most teens
and adults have some degree of gum disease.

If gingivitis is not treated and nothing is done about it, the inflammation will work
its way down towards the foundations of the tooth causing a "periodontal pocket".
Again, within the confines of the pocket, the conditions are such that the bacteria
can have a right old party, and cause more damage.

Gum disease can break down the support (bone) structures of the teeth, so that eventually,
they will become loose. The problem is that until it gets quite severe, the person often
has no symptoms. Sadly, the damage to the support structures of the teeth is irreversible.
The good news is that if gum disease is caught in time, its progression can be halted
and improved upon, and that is the key.

To stop gum disease from progressing, we advise periodontal therapy, or deep cleaning.
This gets rid of the bacteria in the pocket and provides the necessary conditions for
healing to occur.

What is the difference between an ordinary cleaning and deep cleaning?

There is some confusion about the difference between scaling and root planning.
Scaling is basically the process of removing dental tartar from the surfaces of the teeth.
Root planning is the process of smoothening the root surfaces and removing any infected tooth
structure.If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened,
thereby allowing tartar deposits to form under the gumline.

Does it hurt?

Most cases none at all. As an alternative to injectable anesthetics, we use liquid
anesthetic under the gums as an option. It is a special non-injection device that
delivers anesthetic gently into the gum pockets thereby avoiding numbing of the
lips and or tongue as can occur with injected local anesthetics.

How long does it take?

Typically with deeper pockets and extensive rough root surfaces, the deep scaling
and root planning procedure is typically done in one visit.

Any discomfort you may have after your appointment can be handled by taking Advil
or Tylenol, or both. New research is indicating that pain relief comparable to narcotics
but without the side effects can be achieved with only 400mg of ibuprofen (Advil)
and 1000mg acetaminophen (Tylenol).